Provider Demographics
NPI:1770756496
Name:G. EARL HYDRICK, D.D.S.; P.A.
Entity type:Organization
Organization Name:G. EARL HYDRICK, D.D.S.; P.A.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:G
Authorized Official - Middle Name:EARL
Authorized Official - Last Name:HYDRICK
Authorized Official - Suffix:
Authorized Official - Credentials:DDS; PA
Authorized Official - Phone:205-750-8008
Mailing Address - Street 1:600 UNIVERSITY BLVD E
Mailing Address - Street 2:SUITE B-3
Mailing Address - City:TUSCALOOSA
Mailing Address - State:AL
Mailing Address - Zip Code:35401-2067
Mailing Address - Country:US
Mailing Address - Phone:205-750-8008
Mailing Address - Fax:205-750-8152
Practice Address - Street 1:600 UNIVERSITY BLVD E
Practice Address - Street 2:SUITE B-3
Practice Address - City:TUSCALOOSA
Practice Address - State:AL
Practice Address - Zip Code:35401-2067
Practice Address - Country:US
Practice Address - Phone:205-750-8008
Practice Address - Fax:205-750-8152
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-04-03
Last Update Date:2008-04-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL3428261QD0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL510-76357OtherBCBS OF AL.
AL604459OtherUNITED CONCORDIA
AL510-93555OtherBCBS OF AL.